Have you considered a Collagen Injection for Incontinence

Have you considered a Collagen Injection for Incontinence

First, what is Urinary Incontinence?

According to The American College of Obstetricians and Gynecologists (ACOG), urinary incontinence simply means leaking urine. Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.

Symptoms

  • Urgency – Having a strong urge to urinate
  • Nocturia – Waking from sleep to urinate
  • Dysuria – Painful urination
  • Nocturnal enuresis – Leaking urine while sleeping
  • Frequency -Urinating (also called voiding) more often than what is normal for you

Causes

  • Urinary Tract Infections
  • Diuretic medications and caffeine
  • Alcohol
  • Pelvic floor disorders
  • Constipation
  • Neuromuscular problems
What are collagen implants and how does it help?

Collagen implants are one method to help treat incontinence due to a weak sphincter. Collagen is a protein naturally found in the body of animals and humans. Implanting (injecting) animal collagen into the urethra may help close the sphincter and restore most or all control over urine flow.

Collagen is injected around the urethra near the sphincter. The collagen “bulks” the urethral tissue, creating a seal that stops urine from leaking. During urination, the tissue separates naturally to allow urine to flow.

How is it injected?

Collagen implants are usually done in the hospital on an outpatient basis. Local, regional, or general anesthesia may be applied during this procedure. The doctor inserts a cystoscope (a thin, tubelike telescope) into the urethra to better see during the procedure. A needle is inserted (either through the cystoscope or along the outside of the urethra) to the sphincter area. The doctor injects collagen through this needle into the wall of the urethra. The injections make the tissue close up, which stops urine from leaking out of the bladder. 

Types of Injections

According to Medscape.com

Bovine collagen received US Food and Drug Administration (FDA) approval in 1993 for treating women with intrinsic sphincter deficiency. Collagen is a natural protein commonly found in animal bones and connective tissue. The collagen used to treat female urinary incontinence is extracted from cattle, purified, and prepared for use as a bioinjectable agent via cross-linking with glutaraldehyde. When collagen is injected around the urethra, the resultant bulking of periurethral tissue closes off the urethral lumen, which maintains urinary continence.

Patients being considered for periurethral bovine collagen injection must undergo a skin test approximately 4-6 weeks before surgery to determine if they are allergic to this material. Collagen implantation is usually performed in the hospital outpatient setting but it also can be performed in the office. Injected collagen gradually is replaced by host collagen over the next 9-19 months, and usually more than 1 treatment is necessary. The procedure generally has to be repeated after 1 year. Overall, collagen serves as the basis for comparison of most newer agents. 

Calcium hydroxylapatite was approved in 2005 for periurethral injection. The particles are combined with sodium carboxymethylcellulose as a carrier. Studies suggest after dissipation of the carrier that calcium hydroxylapatite particles remain and eventually result in tissue ingrowth and new collagen formation. As is the case with collagen, most patients who receive calcium hydroxylapatite require additional injections after the first year.

A multicenter, prospective, randomized, single-blind study compared calcium hydroxylapatite injection with bovine collagen. A higher proportion of patients who received calcium hydroxylapatite required only 1 injection. In addition, the initial injection volume of calcium hydroxylapatite was less than that of bovine collagen.

Carbon bead particles are non-biodegradable bulking agents that may be as efficacious as collagen. Carbon bead particle injection has been reported to yield outcomes similar to those of collagen injection, without the problem of early reabsorption.

Carbon bead particles may be more difficult to inject than collagen because of increased viscosity and the need for an 18- to 19-gauge needle. If any resistance to the injection is encountered (eg, scar tissue), then the suspension gel tends to flow first and leave the carbon bead particles behind. Otherwise, the development of abscesses or the erosion of carbon bead depots into the urethra has been noted.

Polydimethylsiloxane is a permanent material that can be administered via periurethral injection. The FDA approved its use in 2006, and a randomized prospective study compared it with bovine collagen and found that it achieved excellent efficacy at 12 months. It also appears to be more durable than collagen with regard to length of effect. Concerns for migration were initially raised, but the majority of solid particles in the suspension are over 100 µm in size, making this less of a concern.

Autologous fat, extracted from the patient’s lower abdomen, is an ideal bulking agent because it is inexpensive, readily available, and nonallergenic. However, it is less efficacious than other alternatives. Additionally, because of the rare possibility of fat emboli coupled with poor clinical efficacy secondary to migration and resorption, it is rarely used. Injections may be repeated as required; however, the operative time of the procedure is prolonged because suprapubic fat must be harvested before periurethral injection. Before the FDA approved collagen for use, fat injections were used to treat intrinsic sphincter deficiency by bulking up the urethra.

What are collagen implants and how does it help?

Collagen implants are one method to help treat incontinence due to a weak sphincter. Collagen is a protein naturally found in the body of animals and humans. Implanting (injecting) animal collagen into the urethra may help close the sphincter and restore most or all control over urine flow.

Collagen is injected around the urethra near the sphincter. The collagen “bulks” the urethral tissue, creating a seal that stops urine from leaking. During urination, the tissue separates naturally to allow urine to flow.

How is it injected?

Collagen implants are usually done in the hospital on an outpatient basis. Local, regional, or general anesthesia may be applied during this procedure. The doctor inserts a cystoscope (a thin, tubelike telescope) into the urethra to better see during the procedure. A needle is inserted (either through the cystoscope or along the outside of the urethra) to the sphincter area. The doctor injects collagen through this needle into the wall of the urethra. The injections make the tissue close up, which stops urine from leaking out of the bladder. 

Side Affects

Because incomplete bladder emptying can occur after the onabotulinumtoxinA injection, and some patients may report minimal voiding, many experts recommend an in-office assessment of postvoid residual urine volume by catheterization or bladder ultrasonography postprocedure or when an assessment of bladder emptying is indicated.
Source: ACOG.ORG

How often does it need to be injected?

According to Medscape.com:

A total of 67-96% of women with intrinsic sphincter deficiency remain dry 1 year after injection. After 2 years, 40-49% of incontinent women were cured and 67-83% were either cured or improved. Reports indicate that collagen is a more effective bulking agent than fat. After 4 years, 27% remained cured and 36% remained improved.

The number of injections required to achieve continence varies. Reports have documented injecting 8 mL of bovine collagen during a single treatment. The average number of injections in the first 6 months was 2.2, with an average volume of 9 mL in one study. The average collagen volume injected was 6.1 mL for 11 cases and 3.5 mL for 22 cases in another study.

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